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Counseling Interventions for Children with Anxiety

Updated: Jun 16, 2023

counseling interventions for anxiety

Anxiety is a common problem among children. Each case can be unique with different presenting issues. Some children present with a specific phobia, some with nightmares, and some with OCD, and others with more general anxiety. It can stem from various problems such as a chemical imbalance or trauma. I have found that most interventions also lend themselves as diagnostic tools. As I navigate the triggers, I also find the backstory as to where the anxiety began.

I wanted to offer some of my favorite interventions to use with children who struggle with anxiety. I typically start with coping skills when working with children. It gives them quick relief from symptoms and gives us a chance to establish rapport before digging deeper. One of my favorite games is Fishing for Calming Strategies, which I found on Teachers Pay Teachers. It is a Go Fish game with coping skills as the game cards. While playing it, I ask questions as to which skills the child would prefer using. After the game I like to help them identify different types of coping skills such as exercise, breathing, distractions, ways to process their emotions, and ways to remove themselves from triggers.

I also like to educate kids on how to use progressive relaxation. I like this script. If time allows, the video is also a helpful introduction.



Play therapy is very helpful in giving children a low-stress environment to communicate their feelings. Sand tray therapy allows children to communicate through play situations that trigger anxiety, process trauma, and to create a safe place. This is a good video tutorial of how to use sand tray to help children process anxiety through play and discuss a safe place.

I really liked the idea of a worry web from Pam Dyson. She explains in this video how to use yarn and sticky notes to help children create a worry web. They are able to communicate the size of their feelings through how long they make each piece of yarn and get a visual idea of how different worries intersect in their life. Eventually, they see how they feel trapped by worry.

Art is another fun way for children to communicate their feelings. I provide an outline of a body and let them draw where in their body they feel their anxiety and how it feels. This body awareness helps them become aware of triggers and the need to implement coping skills.

Creating worry monsters is also a fun activity. It allows the children to release their worries. The Worry Whale is the same concept, just with a different format.

There are some good apps available to help children process and cope with anxiety. The Sesame Street Breathe, Think, Do app is helpful with young children to teach them how to do belly breathing.

seseme street breathe, think, do app
Breathe, Think, Do App

Moody Monsters is a cute app that helps increase emotional vocabulary for children to communicate their feelings. I like how it introduces different monsters for the different emotions. It also has some cute interactive games that the kids enjoy. I typically will recommend this app to parents of younger kiddos to play at home.

I have had a difficulty finding many games that focus on cognitive behavioral interventions for anxiety, which is why I created the Trail of Fears game. This game teaches basic CBT skills, coping skills, and body awareness.

Thought Crashers is another CBT game I have available that teaches CBT skills. For children with nightmares, I play my Nightmare Ninja game which teaches children how to rescript nightmares.

For children who have experienced trauma, The Horrible Thing that Happened is a CBT game to help process the situation. I use it to help develop the trauma narrative.

This is a fun idea on how to scale feelings. Children will often struggle with identifying and communicating how severe their feelings are. I find it helpful to compare how strongly the feel towards a situation emotionally compared to how big they think it is logically.

Feelings graphs come in handy as well. I like to have kids to feeling graphs periodically throughout the counseling process to track progress over time. It can be insightful for children to recognize different feelings involved in a situation. Scaling the feelings and identifying various emotions involved can help children sort through things more easily. I will give an analogy that if you had several pieces of string, all of different colors and sizes balled up, that is like our emotions when we are upset. It is difficult to find where one ends and the other begins since they knotted up together. Scaling the feelings is the first step to identifying which feelings are knotted up inside.

Most of the time I just draw out a graph. If you prefer a printed copy you can grab one by clicking on the image above.

I hope these ideas help you develop your counseling tool box. Feel free to comment with other ideas.


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